This application proposes to develop, implement, and evaluate a comprehensive culture-specific and community-based education program for the prevention of eye disease in diabetic Oklahoma Indians. The overall objectives are to increase awareness and knowledge of diabetic eye disease and to improve health behavior and health-care seeking practice in order to prevent or reduce visual impairment and vision loss. The specific aims are: (1) To assess the current knowledge and awareness of diabetic eye disease in the diabetic Oklahoma Indian patients in relation to cultural, socioeconomic, and access factors. (2) Using a multi-disciplinary and multi-institutional approach to develop culture-specific comprehensive educational materials, including clinical and epidemiologic information and basic science principles, for the prevention of eye disease. (3) To disseminate the educational materials developed through a community outreach program with family, tribal, and community support. (4) Through this comprehensive education program, to improve the attitudes of diabetic patients toward prevention of and intervention for diabetic eye disease and consequently improve the health-care seeking practices of these patients. (5) To evaluate the comprehensive education program for its short-term effectiveness and compare it to a more traditional method of information dissemination. In addition, we will investigate cost-effective methods for facilitating access to comprehensive eye examination by primary health care providers and subsequent referral for evaluation and treatment by an ophthalmologist when indicated. The study population will be Native Americans who reside in southwestern Oklahoma. The rates of diabetes in this group have reached epidemic proportions. Available data also indicate high incidence and prevalence of eye disease, particularly retinopathy, among the diabetic patients. Inadequate knowledge, negative attitudes toward prevention and intervention, and poor health-care seeking practices are common in this population. Thus, the proposed education program is urgently needed in order to reduce the burden of diabetic eye disease and reach the goal of "healthy people 2000".